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What Is In Your Ultrasound Gel?

Sunday, June 26, 2011
Suzanne McCoy, MS, RNC, NNP-BC , NICU, Central DuPage Hospital, Winfield, IL
Rita Allen Brennan, DNP, RNC-NIC, APN/CNS , Women & Children's Services, Central DuPage Hospital, Winfield, IL
Ruth Lucas, MS, RNC , Loyola University Chicago, Maywood, IL

Discipline: Newborn Care (NB)

Learning Objectives:
  1. Identify three potential sources of P.aeruginosa in the NICU environment.
  2. State three diagnostic criteria present in the diagnosis of ventilator associated pneumonia.
  3. Describe the systematic process use to identify a causative agent for P.aeruginosa ventilator associated pneumonia in the NICU.

Submission Description:
Background: After 414 days ventilator associated pneumonia (VAP) free, in December 2007, 5 infants exposed to our neonatal intensive care unit were infected with P.aeruginosa.  Three VLBW infants acquired VAP and one infant died of complications after being respiratory culture positive for P. aeruginosa. Additional surveillance resulted in two additional infant's having positive rectal swabs for P. aeruginosa. 

Case:   A detailed epidemiological and environmental investigation of potential sources was carried out to identify the vector source of P. aeruginosa.  These phenotypically similar isolates were examined for genetic relatedness by means of pulse-filed gel electrophoresis and found to be P. aeruginosa positive and matching the five culture positive infants.  These environmental cultures were traced to multi-use ultrasound gel bottles used in performing echocardiograms.   Echocardiograms were changed to use only single use gel packets.

Conclusion: This case study suggests that the prevention of VAP in the NICU is requires multidisciplinary and departmental point of care prevention practices.

Keywords: Ventilator associated pneumonia; P. aeruginosa; ultrasound gel; neonatal intensive care unit

 

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